Cost-Effectiveness of Long-Acting Injectable Paliperidone Palmitate Versus Haloperidol Decanoate in Maintenance Treatment of Schizophrenia

Abstract

Objective This study assessed the relative cost-effectiveness of a first generation and a second generation long-acting injectable antipsychotic: haloperidol decanoate (HD) and paliperidone palmitate (PP), respectively. Methods A multisite, double-blind, randomized 18-month clinical trial conducted at 22 clinical research U.S. sites with adults diagnosed with schizophrenia or schizoaffective disorder (n=311) clinically assessed to benefit from a LAI antipsychotic. Patients were randomly assigned to Intramuscular injections of HD 25–200 mg or PP 39–234 mg every month for up to 24 months. Quality Adjusted Life Years was measured by a schizophrenia-specific algorithm based on the Positive and Negative Syndrome Scale and side effect assessments; and total health care costs from the perspective of the health system. Results Mixed model analysis of QALYs showed PP with .027 greater QALYs over 18 months (p=.03) but also greater average quarterly inpatient, outpatient and medication costs of $2,100/quarter (p<.0001). Bootstrap analysis with 5,000 replications showed an Incremental Cost effectiveness ratio for PP of $508,241/QALY (95% CI of $122,390–$1,582,711). Net Health Benefits analysis showed a 0.98 probability of greater cost-effectiveness for HD over PP at an estimated valuation of health of $150,000/QALY and only 0.50 greater at $500,000/QALY. Conclusions HD was more cost-effective than PP suggesting that PP’s slightly greater benefits do not justify its markedly higher on-patent costs.

Association of current and past opioid use disorders with health-related quality of life and employment among US adults

“…Further, in view of our non-disease specific measure of QALYs, the data presented here make it possible to benchmark the loss of QALYs associated with OUD to those of other behavioral health disorders. In particular, the 0.73 QALY score for OUD is in the same decile as that found in several studies of chronic schizophrenia (Rosenheck et al, 2006;Rosenheck et al, 2016;Thwin et al, 2013), often considered the most disabling of mental disorders. This study is thus the first to situate the adverse effect of OUD with one of the most debilitating illnesses.…”

Real-World Evidence of the Clinical and Economic Impact of Long-Acting Injectable Versus Oral Antipsychotics Among Patients with Schizophrenia in the United States: A Systematic Review and Meta-Analysis

“…In addition to improving adherence, the use of LAI relative to OA may result in considerable medical cost savings due to fewer hospitalizations [ 24 , 25 , 35 – 40 ]. However, despite the large volume of real-world evidence on the economic burden and adherence patterns of patients with schizophrenia prescribed LAI versus OA in the US [ 23 – 26 , 35 , 37 , 40 – 42 ], there is, to the best of the authors’ knowledge, no recent comprehensive synthesis of these publications.…”

Efficacy and safety profile of paliperidone palmitate injections in the management of patients with schizophrenia: an evidence-based review

“… 42 In a relative cost-effectiveness study in the same cohort, mixed-model analysis showed that PP-1M was associated with 0.0297 greater quality-adjusted life years over 18 months ( P =0.03), but with higher average costs for inpatient and outpatient services and medication compared with haloperidol decanoate ( P <0.001). 43 …”